TN 56 (09-26)

DI 39506.270 Ordering Financial Management Forms

Procedure

Disability Adjudication (DA), State Disability Resource Management Division (SDRM) will release the electronic financial management forms via email. The State DDSs can obtain the electronic forms from DA. The forms will also be available electronically via the DA SDRM Intranet website.

The financial management forms include:

  • SSA-872, State Agency Obligational Authorization for SSA Disability Programs

  • SSA-4513, State Agency Report of Obligations for SSA Disability Programs

  • SSA-4513 Addendum, State Agency Report of Obligations for SSA Disability Programs

  • SSA-4514, Time Report of Personnel Services for Disability Determination Services

  • SSA-871, State Agency Schedule of Equipment Purchased for SSA Disability Programs


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0439506270
DI 39506.270 - Ordering Financial Management Forms - 09/03/2026
Batch run: 09/03/2026
Rev:09/03/2026